Wang Guo-Quan, Qin Ya-Fei, Shi Shuai-Tao, Zhang Ke-Wei, Zhai Shui-Ting, Li Tian-Xiao
Department of Vascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China.
Front Cardiovasc Med. 2023 Jul 21;10:1160142. doi: 10.3389/fcvm.2023.1160142. eCollection 2023.
This article aims to investigate the incidence rate of retrograde type A aortic dissection (RTAD) and the risk factors of RTAD in relation to thoracic endovascular aortic repair (TEVAR).
Patients with thoracic aortic disease who underwent TEVAR at Henan Provincial People's Hospital from January 2004 to December 2019 were enrolled in the present research. The risk factors associated with RTAD following TEVAR using univariate and multiple logistic regression analyses.
During the study period, A total of 1,688 TEVAR patients were included in this study, and of these, 1,592 cases were included in the type B aortic dissection (TBAD) group, and 96 cases were included in the non-TBAD group. There were 1,230 cases of aortic dissection and 362 cases of aortic intramural hematoma and/or penetrating ulcer in the TBAD group. The non-TBAD group included 68 cases of thoracic aortic aneurysm, 21 cases of thoracic aortic pseudoaneurysm, and seven cases of congenital aortic coarctation. The overall incidence rate of RTAD was 1.1% (18/1,688) in patients, all of which occurred in the TBAD group. The cohort comprised 18 RTAD patients with an average age of 56.78, consisting of 13 males and 5 females. Among them, 13 individuals exhibited hypertension. Ten instances happened within the TEVAR perioperative period, including two cases during the surgery, six cases occurred within three months, two cases occurred after one year, and the longest interval was 72 months following TEVAR. TEVAR was successfully implemented in 17 patients, while the operation technique was temporarily altered in one case. The new entry position for RTAD was identified as the proximal region of the stent graft (SG) in 13 patients, while in five cases, the entry site was more than 2 cm away from the proximal region of the SG. 17 cases were at the greater curvature of the aorta, and one case was at the lesser curvature. Multivariate logistic regression analysis revealed that the SG oversizing ratio is a relevant risk factor for RTAD. However, ascending aortic diameter, aortic arch type, SG type, and anchored region were not directly related to the occurrence of RTAD.
RTAD is a rare yet catastrophic complication. It could occur both during the procedure, early and late postoperative periods. Maintaining an appropriate SG oversizing ratio is crucial to minimize the risk of RTAD.
本文旨在研究逆行A型主动脉夹层（RTAD）的发病率以及与胸主动脉腔内修复术（TEVAR）相关的RTAD危险因素。
纳入2004年1月至2019年12月在河南省人民医院接受TEVAR治疗的胸主动脉疾病患者。采用单因素和多因素逻辑回归分析TEVAR术后与RTAD相关的危险因素。
研究期间，本研究共纳入1688例TEVAR患者，其中1592例纳入B型主动脉夹层（TBAD）组，96例纳入非TBAD组。TBAD组中有1230例主动脉夹层和362例主动脉壁内血肿和/或穿透性溃疡。非TBAD组包括68例胸主动脉瘤、21例胸主动脉假性动脉瘤和7例先天性主动脉缩窄。患者中RTAD的总体发病率为1.1%（18/1688），均发生在TBAD组。该队列包括18例RTAD患者，平均年龄56.78岁，其中男性13例，女性5例。其中13例患有高血压。10例发生在TEVAR围手术期，包括手术期间2例，3个月内6例，1年后2例，TEVAR后最长间隔72个月。17例患者成功实施了TEVAR，1例手术技术临时改变。13例患者RTAD的新破口位置位于支架移植物（SG）近端区域，5例破口部位距离SG近端区域超过2 cm。17例位于主动脉大弯处，1例位于小弯处。多因素逻辑回归分析显示，SG尺寸过大率是RTAD的相关危险因素。然而，升主动脉直径、主动脉弓类型、SG类型和锚定区域与RTAD的发生无直接关系。
RTAD是一种罕见但灾难性的并发症。它可发生在手术过程中以及术后早期和晚期。保持合适的SG尺寸过大率对于将RTAD风险降至最低至关重要。
